AIDS

Moving targets

Progress, and problems, in treating AIDS around the world

ROUGHLY 30m people are infected with HIV, the virus that causes AIDS. The vast majority live in the poorer parts of the planet. Of these, an estimated 6.5m are in urgent need of anti-retroviral medicines—the cocktails of drugs that have, in rich countries, transformed AIDS from an acute lethal condition to a chronic complaint. Two years ago a concerted international effort was launched to get 3m of these people on to anti-retroviral therapy by the end of 2005—the “3 by 5” campaign as the World Health Organisation (WHO) dubbed it.

This week the WHO and UNAIDS, another United Nations body with responsibility for dealing with the disease, reported on progress so far. The good news is that the number of people now getting the drugs stands at roughly 1m—more than double what it was at the end of 2003. The bad news is that this achievement is 600,000 patients short of the mid-2005 target set by the WHO, which means that “3 by 5” looks like turning into “3 by 6” instead. Progress has been slower than expected, says Jim Kim, head of the WHO's HIV/AIDS department, in part because of bottlenecks in setting up procurement and supply-chain management in poor countries. There have also been problems training enough nurses and other health-care workers—the unglamorous bits of improving health-care systems.

While the shortfall is disappointing, there are some encouraging signs. Four years ago, a basic cocktail of anti-retroviral medicines cost $10,000 a year. Today that price has fallen to around $150 in many countries. The dramatic decline is thanks largely to the introduction of cheap generic medicines from Indian manufacturers and others, as well as discounting by multinational drug giants. That is not to say that drug prices and patents are no longer controversial. Last week, the Brazilian government said it would break the patent on an anti-retroviral drug produced by Abbott Laboratories, an American company, unless that firm agreed to match the much lower price of local manufacturers.

As the ever-optimistic Dr Kim points out, there are other positive developments, too. More poor countries are making AIDS a national priority, setting treatment targets and concrete plans for how to reach them. As treatment becomes available, more people are also turning up for counselling and testing, which in turn helps with AIDS prevention. And despite initial fears that women might have problems gaining access to treatment, there are as yet no signs of them losing out.

There is more money, too, with an estimated $27 billion to tackle AIDS on offer between 2005 and 2007. This is, however, still $18 billion short of what UNAIDS says is needed to get the job done. And there are serious obstacles to obtaining treatment if you are an intravenous drug user, a homosexual or a prostitute. In that case some squeamish governments—both of rich donor countries and poor recipients—would prefer not to deal with you. By far the biggest challenge, though, is not simply getting 3m people on to anti-retroviral therapy by the end of this year, but keeping them, and millions of others, on it for the rest of their lives.